<div class="page-header">
<h1>購入情報登録</h1>
</div>

<form class="form-horizontal" role="form" name="customer" action="<?php echo base_url(); ?>index.php/customer/guest_regist" method="post">

	<!-- email -->
	<div class="form-group">
		<label for="email" class="col-sm-2 control-label">EMAIL</label>
		<div class="col-sm-6">
			<?php if (empty($email)): ?>
				<input type="email" class="form-control" id="email" name="email" value="" placeholder="EMAIL">
			<?php else: ?>
				<input type="email" class="form-control" id="email" name="email" value="<?=$email?>" style="background-color:lavenderblush;">
			<?php endif; ?>
		</div>
	</div>

	<!-- first_name -->
	<div class="form-group">
		<label for="first_name" class="col-sm-2 control-label">性</label>
		<div class="col-sm-4">
			<input type="text" class="form-control" id="first_name" name="first_name" required value="<?php echo empty($first_name)?"":$first_name;?>" placeholder="性">
		</div>
	</div>

	<!-- last_name -->
	<div class="form-group">
		<label for="last_name" class="col-sm-2 control-label">名</label>
		<div class="col-sm-4">
			<input type="text" class="form-control" id="last_name" name="last_name" required value="<?php echo empty($last_name)?"":$last_name;?>" placeholder="名">
		</div>
	</div>

	<!-- first_name_kana -->
	<div class="form-group">
		<label for="first_name_kana" class="col-sm-2 control-label">性（カナ）</label>
		<div class="col-sm-4">
			<input type="text" class="form-control" id="first_name_kana" name="first_name_kana" required value="<?php echo empty($first_name_kana)?"":$first_name_kana;?>" placeholder="性（カナ）">
		</div>
	</div>

	<!-- last_name_kana -->
	<div class="form-group">
		<label for="last_name_kana" class="col-sm-2 control-label">名（カナ）</label>
		<div class="col-sm-4">
			<input type="text" class="form-control" id="last_name_kana" name="last_name_kana" required value="<?php echo empty($last_name_kana)?"":$last_name_kana;?>" placeholder="名（カナ）">
		</div>
	</div>

	<div class="form-group">
		<label for="last_name_kana" class="col-sm-2 control-label">郵便番号</label>
		<div class="col-sm-2">
			<input type="text" class="form-control" id="zip21" name="zip21" maxlength="3"　required value="" placeholder="335"> -
			<input type="text" class="form-control" id="zip22" name="zip22" maxlength="4" required onKeyUp="AjaxZip3.zip2addr('zip21','zip22','pref21','addr21','strt21');"> 
		</div>
	</div>
	<div class="form-group">
		<label for="last_name_kana" class="col-sm-2 control-label">都道府県</label>
		<div class="col-sm-4">
			<input type="text" class="form-control" id="pref21" name="pref21" required/>
		</div>
	</div>
	<div class="form-group">
		<label for="last_name_kana" class="col-sm-2 control-label">市町村区</label>
		<div class="col-sm-4">
			<input type="text" class="form-control" id="addr21" name="addr21" required/>
		</div>
	</div>
	<div class="form-group">
		<label for="last_name_kana" class="col-sm-2 control-label">以降の住所</label>
		<div class="col-sm-4">
			<input type="text" class="form-control" id="strt21" name="strt21" required/>
		</div>
	</div>
	<div class="form-group">
		<div class="col-sm-offset-2 col-sm-10">
			<button type="submit" class="btn btn-default">送信する</button>
		</div>
	</div>

</form>

